Dyshidrotic eczema. This example is characterized by deep-seated vesicles and scaling on palms and lateral fingers, and the disease is often associated with an atopic diathesis. The evaluation of a patient with hand eczema should include an assessment of potential occupation-associated exposures. The history should be directed to identifying possible irritant or allergen exposures. Hand Eczema: Treatment Therapy of hand dermatitis is directed toward avoidance of irritants, identification of possible contact allergens, treatment of coexistent infection, and application of topical glucocorticoids. Whenever possible, the hands should be protected by gloves, preferably vinyl. . | Chapter 053. Eczema and Dermatitis Part 4 Figure 53-2 Dyshidrotic eczema. This example is characterized by deep-seated vesicles and scaling on palms and lateral fingers and the disease is often associated with an atopic diathesis. The evaluation of a patient with hand eczema should include an assessment of potential occupation-associated exposures. The history should be directed to identifying possible irritant or allergen exposures. Hand Eczema Treatment Therapy of hand dermatitis is directed toward avoidance of irritants identification of possible contact allergens treatment of coexistent infection and application of topical glucocorticoids. Whenever possible the hands should be protected by gloves preferably vinyl. The use of rubber gloves latex to protect dermatitic skin is sometimes associated with the development of hypersensitivity reactions to components of the gloves. Patients can be treated with cool moist compresses followed by application of a mid- to high-potency topical glucocorticoid in a cream or ointment base. As with atopic dermatitis treatment of secondary infection is essential for good control. Additionally patients with hand dermatitis should be examined for dermatophyte infection by KOH preparation and culture see below . Nummular Eczema Nummular eczema is characterized by circular or oval coinlike lesions beginning as small edematous papules that become crusted and scaly. The etiology of nummular eczema is unknown but dry skin is a contributing factor. Common locations are the trunk or the extensor surfaces of the extremities particularly on the pretibial areas or dorsum of the hands. It occurs more frequently in men and is most commonly seen in middle age. The treatment of nummular eczema is similar to that for atopic dermatitis. Asteatotic Eczema Asteatotic eczema also known as xerotic eczema or winter itch is a mildly inflammatory dermatitis that develops in areas of extremely dry skin especially during the dry winter months. Clinically .
